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ANaESTHESIA Presented By :- Mahesh Deore 1 ANESTHESIA


DEFINITION “Anaesthesia means reversible loss of sensation.” OR “Anaesthesia has been defined as a reversible loss of sensation in a circumscribed area/ whole body caused by a depression of excitation in nerve endings or an inhibition of the conduction process in peripheral nerves.” 2 ANESTHESIA

Properties of an ideal anaesthetic : 

Properties of an ideal anaesthetic For the patient :- It should be pleasant, non-irritating, should not cause nausea or vomiting. Induction and recovery should be fast with no after effects. For the surgeon :- It should provide adequate analgesia, immobility and muscle relaxation. For the anaesthetist :- Its administration should be easy, controllable & versatile. - Heart, liver & other organs should not be affected. - Rapid adjustments in depth of anesthesia should be possible. 3 ANESTHESIA

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Types of Anaesthesia General Local Inhalational Non-inhalational (intravenous) Topical Local infiltration Field block Nerve block 4 ANESTHESIA

General anaesthesia : 

General anaesthesia Definition :- “General anaesthetics (GAs) are drugs which produce reversible loss of all sensation & consciousness.” 5 ANESTHESIA

Types : 

Types Inhalational anaesthesia :- - It is achieved by breathing gaseous or volatile narcotic agents. 6 ANESTHESIA Forms Gaseous Volatile liquid Nitrous oxide Ether Halothane etc.

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Non-inhalational :- - These are drugs which on i.v. injection produce loss of consciousness in one arm-brain circulation time (~11 sec). - Are generally used for induction because of rapidity of onset of action. - Anaesthesia is then usually maintained by an inhalational agent. - Agents: Thiopentone sodium, propofol. 7 ANESTHESIA

Local anaesthesia : 

Local anaesthesia Definition :- “local anaesthesia has been defined as a reversible loss sensation in a circumscribed area of the body caused by a depression of excitation in nerve endings or an inhibition of the conduction process in peripheral nerves.” ANESTHESIA 8

Classification of L.A.(based on chemistry) : 

Classification of L.A.(based on chemistry) Esters :- - Butacaine - Cocaine - Procaine Amides :- - Articaine - Lidnocaine - Bupivacaine Quinoline :- - Centbucridine ANESTHESIA 9

Composition of L.A. : 

Composition of L.A. ANESTHESIA 10 * Methylparaben is no longer included in single-use dental cartridges of local Anaesthetic ; however it is found in ALL multidose vials of injectable drugs.

Three types of L.A. injection : 

Three types of L.A. injection Local infiltration Field block Nerve block ANESTHESIA 11

1. Local infiltration : 

1. Local infiltration In local infiltration, small terminal nerve endings in the area of the surgery are flooded with local anesthetic solution. ANESTHESIA 12 Incision is made into the same area in which the LA has been deposited

2. Field block : 

2. Field block Method of securing regional anesthesia consisting of depositing a suitable LA solution in proximity to the large terminal nerve branches. Incision is made into an area away from the site of injection ANESTHESIA 13

3. Nerve block : 

3. Nerve block Method of securing regional anesthesia by depositing LA solution within close proximity to a main nerve trunk Usually at a distance from the site of operative intervention ANESTHESIA 14

Other injection techniques : 

Other injection techniques Intraligamentry Intraseptal Intrapulpal Intraosseous injection Jet injector Computer controlled local anesthetic delivery system Electronic dental anesthesia Topical anesthesia ANESTHESIA 15

Intraligamentry : 

Intraligamentry Indications Contraindications 1. Pulpal anesthesia of one or two teeth in a quadrant 2.Treatment of isolated teeth in two mandibular quadrant. 3. Patient for whom residual soft tissue anesthesia is undesirable 4. Situations in which regional block is contraindicated 1. Infection or inflammation at the site of injection 2. Primary teeth when the permanent tooth bud is present 3. Patient who requires a “numb” sensation for psychological discomfort ANESTHESIA 16

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ANESTHESIA 17 Instruments Area anaesthetise Site of injection Site of injection

Intraseptal injection : 

Intraseptal injection Indications When both haemostasis & pain control are desired for soft tissue & osseous periodontal treatment Contraindications Infection or severe inflammation at the site of injection ANESTHESIA 18

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ANESTHESIA 19 Site of injection Angle of needle

Intrapulpal injection : 

Intrapulpal injection ANESTHESIA 20 Deposition of LA directly into the pulp chamber of a pulpally involved tooth provides effective anesthesia for pulpal extirpation & instrumentation where other techniques have failed.

Intraosseous injection : 

Intraosseous injection Indications Contraindications Pain control for dental treatment on single or multiple teeth in a quadrant Infection or severe inflammation at the site of injection ANESTHESIA 21

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ANESTHESIA 22 Drill hold using a gentle pecking motion Leave the guide sleeve in place as drill is removed Insert needle into guide sleeve & inject local anesthetic solution

Jet injector : 

Jet injector Principle- based on principle that liquid forced through very small openings, called jets, at very high pressure can penetrate intact skin or mucous membrane The primary use of jet injector is to obtain topical anesthesia before the insertion of a needle In addition it may be used to obtain mucosal anesthesia of palate. ANESTHESIA 23

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Advantages Disadvantages 1. Does not require use of needle 2. Delivers very small amount of LA Is inadequate for pulpal anesthesia or regional anesthesia 2. May damage periodontal tissue 3. Many patients dislike the feeling accompanying use of the jet injector 4. Post-injection soreness of soft tissue may develop ANESTHESIA 24

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ANESTHESIA 25 Instrument kit Technique

Computer-controlled local anesthetic delivery system : 

Computer-controlled local anesthetic delivery system The system enables a dentist or hygienist to accurately manipulate needle placement with fingertip accuracy and deliver the LA with a foot-activated control ANESTHESIA 26

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ANESTHESIA 27 Advantages Precise control of flow rate & pressure, hence a more comfortable injection Increased tactile feel Non-threatening Automatic aspiration Rotational insertion technique minimizes needle deflection Disadvantages Need for additional armamentarium 2. Increased cost

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ANESTHESIA 28 Instrument kit

Electronic Dental Anesthesia : 

Electronic Dental Anesthesia The method of achieving local anesthesia involves the use of the principle of transcutaneous electrical nerve stimulation {TENS} which has been used for the relief of pain ANESTHESIA 29

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Indications In patients with needle phobia Ineffective LA Instances where LA cannot be administered Contraindications Cardiac pacemakers Neurological disorders Pregnancy Very young pediatric patients Older patients with senile dementia ANESTHESIA 30

Slide 31: 

ANESTHESIA 31 EDA unit For comfortable administration of L.A.

Slide 32: 

ANESTHESIA 32 For treatment without L.A.

Topical application : 

Topical application Anesthesia obtained by the application of a suitable agent to an area of either the skin or mucous membrane which it penetrates to anesthetize superficial nerve endings Spray Ointments & jelly EMLA (Eutectic mixture of LA) ANESTHESIA 33

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Local complications : 

Local complications Needle breakage Paresthesia Facial nerve paralysis Trismus Hematoma Soft tissue injury Burning on injection ANESTHESIA 35

General complications : 

General complications Overdose Allergic reaction ANESTHESIA 36

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